Provider Demographics
NPI:1477806149
Name:IVETTE C CRUZ CABRERA
Entity Type:Organization
Organization Name:IVETTE C CRUZ CABRERA
Other - Org Name:DBA LABORATORIO CLINICO DOMUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IVETTE
Authorized Official - Middle Name:C
Authorized Official - Last Name:CRUZ CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-544-0600
Mailing Address - Street 1:PO BOX 479
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-0479
Mailing Address - Country:US
Mailing Address - Phone:787-544-0600
Mailing Address - Fax:787-544-0600
Practice Address - Street 1:CARR 486 KM 1.9 BARRIO ZANJAS
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627
Practice Address - Country:US
Practice Address - Phone:787-544-0600
Practice Address - Fax:787-544-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1273291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory